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2024 LPS Summer Clinic Registration, WAIVER, RELEASE AND ASSUMPTION OF RISK (Parent)
This form MUST be filled out PRIOR to your student using LPS Facilities.
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Email
*
Your email
Please Complete One Form for each Child
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student LPS ID #
Your answer
Student Qualified for Free/Reduced Lunch during the 23-24 School Year
Yes
No
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Grade for the 2024-25 school year
*
Choose
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
School the student will attend during the 2024-25 school year?
*
Your answer
Emergency Contact (First and Last Name)
*
Your answer
Emergency Contact Phone #
*
Your answer
Next
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